An Empirical Analysis from TurkeyABSTRACT The aim of this study is to determine the main factors impacting on cigarette smoking habits of university students. In order to achieve this aim, the primary data obtained from face to face questionnaire conducted with 260 university students were used for Zero Altered Poisson Regression Model. The results of the study showed that the studentsâ age ranged 18-35 years and 55.4 percent of them were women. Besides, 23.0 percent of the total students smoked, and 83.3 percent of them were men. Average monthly cigarette consumption amount were 5 packs per student. The results highlighted that of 19 factors the effected on smoking, 16 were statistically significant. If the prohibitions applied by government on smoking are implemented, and cigarette taxes are increased, it could be decreased smoking rates of young people. By being conducted effective companies related to public health on social and real media, smoking rate could be decreased considerably.
INTRODUCTION
Cigarette is a product made from tobacco leaves, thin paper and filter manufactured by using machine for smoking (Anonymous 2015a). Tobacco leaves rolled in thin paper and then they as a cigarette are packed in twenties bunched. A cigarette is used by the consumers by being burned, and then they inhale and exhaled smoke of cigarette by means of their mouth. There are 4000 chemical in cigarette, and these chemicals include the substances such as nicotine, carbon monoxide, acrolein, and oxidant (Mudhovozi and Nyanga 2015; Csordas and Bernhard 2013; Seget et al. 2011). Over 1.3 percent of these chemicals are carcinogenic substances (Seget et al. 2011).
According to World Health Organization (WHO), in recent years, about 50.0 percent of cigarette smokers have died from the tobacco-related diseases (WHO 2013 and 2008). Cigarette exposes the health problems for not only the cigarette smokers but also the passive smokers who donât used cigarette, but are found with smokers in the same environment. Actually, approximately 1.0 percent of passive smokers have died from the ones, and 61.0 percent of these dying persons are the children (Ossip 2013; Oberg et al. 2011). Proportion of households with at least one individual in smoking habit is 54.2 percent, and with at least one child (0-17 years) is 33.8 percent in 2013 (TURKSTAT 2015).
Smoking rate was reported as 48.0 and 15.0 percent for men and women in the worldwide in 2010s, respectively (Iovino et al. 2012). According to Global Adult Tobacco Survey (GATS), approximately 16 million people used the tobacco products, and smoking rate was 31.2 percent in Turkey in 2008. Also, these proportions for men and women were 47.9 and 15.2 percent, respectively (GATS 2010). In Turkey in 2012, on the other hand, about 14.8 million people (27.1%) used tobacco products, and smoking proportion for men and women were calculated as 41.5 percent and 13.1 percent, respectively (GATS 2014). Compared the smoking rates in 2008 and 2012, smoking tendency decreased considerably. The most important factors on this decreasing were the cigarette smoking prohibition in all indoor spaces in Turkey since May 19, 2008 (Anonymous 2015a), mandatory pictorial warnings added on cigarette packs, and cigarette prices raised by Turkish government (GATS 2014).
While smoking rate has decreased generally in developed countries, it has also increased steadily for women and children in developing countries in recent years. Therefore, cigarette marketers have developed the effective marketing tactics and strategies for women and young people in developing countries (Gil-Lacruz et al. 2015). The first international tobacco control treaty, Framework Contract on Tobacco Control, was underwritten in Geneva on May 21, 2003. This legally binding treaty given the powerful new tools to the nations to protect the health of their nationals from the tobacco industryâs deceptions and slick marketing (Oguzturk and Gulcu 2012; Anonymous 2015b). As a result of this treaty, the Ministry of Health in Turkey arranged âAction Plan of National Tobacco Control Programâ, and put into effect it quickly. The main intention of this program was to increase the rates of non-smokers over and under 15 years to 80.0 and 100.0 percent until 2010 years in Turkey, respectively (Oguzturk and Gulcu 2012).
However, smoking rates have started to rise again after 2012 years in Turkey due to the deficiencies in the application of the laws preventing smoking, and the inefficiency of local public controls with regard to smoking. Especially, smoking habits among young people, therefore, has started to increase critically. They were stimulated to smoke by the most important motivation sources under the effects of references groups such as their families, collage friends/mates, role-model persons, etc.
Their smoking rates have increased considerably their exposed expenditure rates within total disposable income. Total cost of their smoking includes not only the cigarette materials but also the medical expenditures undertaken with smoking. When considered only their cigarette material expenditure per households in 2013, their total cigarette material cost was calculated as $197.8 ($53.5*3.7 persons) with average $53.5 expenditure per capita. This value calculated for only cigarette material was approximately half of the minimum wage ($404.7) in Turkey (TURKSTAT 2015). When added the medical expenditures to this cost calculated, total cost of smoking has reached to higher figures for young people in recent years. In order to eliminate the cost pressures on national economy, and to provide a more healthy population; the governments have always cautioned the young smokers by means of effective anti-smoking campaigns by administering controlled the laws preventing smoking.
In recent studies conducted by some researchers, it were argued that the young smokers must be often warned by anti-smoking campaigns, and it should be also cut the links with their reference groups stimulated by motivating their smoking. Actually, the results of the studies conducted by Gil-Lacruz et al. (2015) and Mansour et al. (2015) reported that the increasing rate smoking of young and women were worrisome, and thus they should be informed about the adverse health effects of cigarette under several campaigns carried out the governments. On the other hand; it were highlighted that the religious beliefs, the most respected persons, parents and friendsâ smoking attitudes and behaviors were strongly associated with studentsâ smoking (Mansour et al. 2015; Mudhovozi and Niyanga 2015; Akl et al. 2013; Rhodes and Ewoldsen 2009; Kear 2002; Whooley et al. 2002).
In light of all these results, determining the core motivation sources of young smokers is of paramount importance to conduct the effective anti-smoking campaigns preventing their smoking. This study was, thus, designed to determine the factors influencing on smoking habits of the university students, and then to make some recommendations to university students, and to help them reduce their smoking by considering these factors.
MATERIAL AND METHOD
Material
The main material of the research was obtained from face-to-face interviews conducted with 260 students in May 2014 at Bayburt University. On the other hand, the data obtained from various institution and organizations as well as the scientific research project reports and papers also included in the secondary data of the study.
Method
Sampling method
According to the information obtained from the student affairs, the sample size was determined. In order to calculate the sample size, the following equation was used (Newbold 1995).
(1) Ï_p^2=(r/z_(α/2) )^2=(0.05/1.64)^2=0.00093 (2)
Where,
n = sample size (260)
N= student population (the number of students educated at the university) (5842)
p = smoking probability (0.5)
Zï¡/2: = z value (1.64 for 90% confidence level),
Ï2p : variance
r: deviation from the average (±0.05)
Participants
This study was carried with 260 participants, and they were randomly selected from four faculties including in engineering, education, economics and administrative sciences and technology. By taking into consideration the numbers of the women and men students in each faculty, it was determined their numbers proportionally. The number of women participants was higher than that of men (144 women and 116 men).
Instrumentation
The number of questionnaires was of 32 items revised and obtained from previous studies, and then these surveys were presented in four sections to the participants. First and second sections covered the socioeconomic and demographic characteristics, and daily life activities and study conditions of the students. Third and final sections included in the cigarette quantity used and total cigarette expenditure of the students, and their attitude and behaviour towards smoking. Participants of the study were asked to answer to each statement stating the significance level of smoking attributes for them. A likert-type scale was used (where 1 refers to the least important and 5 refer to the most important attribute).
Pilot study
In order to prepare the final survey forms, a pilot study was administered by the researcher. In order to test whether the students understood the questionnaires or not, and whether the questionnaires were wrong and deficient, a pre-survey study was designed, and then it was pressed the final survey forms following the necessary corrections.
Data collection
After the aim of the study was explained clearly to the students, the answers of the students were marked to the final survey forms by researcher within 15-20 minutes, and all survey study was completed in May 2014. Following the data collected, the data were controlled and then entered into the computers by researcher.
Statistical analyses
Limdep 4.0 statistical package program was used for Zero Altered Poisson Regression model analyse. The analysis was applied to measure the effects on smoking of the socioeconomic and demographic characteristics along with the behavioural attributes of the young consumers. The parameter coefficients in the analysis were estimated by Zero Altered Poisson Regression model. Individual and group significances of these coefficients were tested using z and Tau and log-likelihood statistics, respectively. In order to evaluate whether to be any econometrical problem among the variables, it was tested by considering the variance-inflating factor (VIF) and Durbin-Watson d statistics, respectively. Multicollinearity among variables was detected by calculating (VIF) (Gujarati 2005).
Ethical consideration and human rights
After getting the assents of the respondents, giving detailed information and explanations about the questionnaires, and explaining to be not recorded with writing of confidential individual information (name, phone number, address etc.); the survey study was started. On the other hand, it was also stated that if the respondents were bored and tired, they could be separated from the questionnaire without answering so that they did not remained under a psychological effect.
RESULTS
The demographic and socioeconomic characteristics of the students smoking and non-smoking were showed in Table 1. The data obtained from 260 participants (144 women, 116 men) ranging 18 and 35 years. While 55.4 percent of the respondents were the female, and their 7.0 percent smoked, smoking rate of the male were 43.1 percent. Although the average ages of the female and male were 21.9 and 22.9 years, those of smoking female and male were 23.0 and 23.3 years. The results represented that the majority of the students started smoking in the first years of university education.
Table 1 could be inserted here
Average monthly expenditures and smoking expenditures of the female and male were $258.3 and 308.0, $3.7 and 32.8, respectively. On the other hand, whereas those of smoking female and male were $335.7 and 53.3, and $365.7 and 76.0; average monthly expenditures of non-smoking female and male were $252.5 and 263.9 (Table 1). Consequently, smoking male spent more than the women.
Residence places living in the students smoking and non-smoking were listed Table 2. Even though 48.8 percent of the students lived in rental apartments, 46.9 and 4.3 percent of those stayed the public and private dormitories, and in other places. While the majority of smoking respondents resided in the rental apartments; that of non-smoking students inhabited in the dormitories.
Table 2 could be inserted here
The attitudes related to the media usage of the students smoking and non-smoking showed in Table 3. Smoking and non-smoking students spent daily much more time on the internet (for e-mail, scientific researches, news etc.) than the others. However, they also used similarly the social media (Facebook, twitter, chat etc.) following internet communication. On the other hand, while they watched TV for 2.14 hours per day, they slept daily during 7.8 hours. Smoking and non-smoking students, therefore, exhibited the similar attitudes towards the real and social media.
Table 3 could be inserted here
Some health-related attitudes of the students smoking and non-smoking were reported in Table 4. Average body mass index for the respondents were calculated as 22.7; however, that of smoking students were bigger (23.5) than that of the others. On the other hand, the rates of chronic diseases, regularly having breakfast and making regular exercise for smoking students were lower than those of non-smoking students.
Table 4 could be inserted here
Weighted grade point average (WGPA) of the students smoking and non-smoking were given in Table 5. The rate of the participants with the score higher than 2.4 WPGA was 61.5 percent. However, that of smoking students with 2.4 WPGA was 43.3 percent lower than that of non-smoking (52.5%). As a result, non-smoking students are successful more than smoking students.
Table 5 could be inserted here
The attitudes of smoking students towards smoking were showed in Table 6. Smoking students stated that they smoked more when cigarette price came down by appreciating the most important to its brand. On the other hand, smoking students believed that the moderate attributes impacting on their smoking were their friend environment, the idea of stress reduction, smoking addiction and smoking prohibition indoors.
Table 6 could be inserted here
The attitudes of non-smoking students towards non-smoking were depicted in Table 7. It was represented that the most important motivation attributes preventing smoking for the respondents were yellowing of the teeth, high smoking cost and fear to reaction from family and friends, following the harmful effects on human health, and the smell and smoke after smoking. Smoking ban indoors and non-smoking friend selections, however, were of the lowest impact on the attributes preventing smoking.
Table 7 could be inserted here
The empirical results of Zero Altered Poisson Regression Model were represented in Table 8. The result of the analysis highlighted that there were the positive relationships among each attributes such as fourth graders, tea and water consumptions, total expenditure, public dormitories, internet using, making sports, having breakfast, chronic diseases and monthly cigarette smoking amounts of the participants. On the other hand, there was an converse connection between the cigarette prices, education in engineering faculty, gender, age, BMI, watching TV, awake up early, less sleeping, GPA and monthly cigarette smoking amounts of the participants. All these attributes were of a great important in terms of the behavioral science theory and statistical tests (p<0.01, 0.05 and 0.10).
Table 8 could be inserted here
DISCUSSION
As known, although smoking caused various diseases on living organisms, smoking rate has increased dramatically in the young generations of developing countries in recent years. The results of the present study were supported by this scenario with about 25.0 percent smoking rate of the respondents, and with 23.2 average ages of smoking students. In order to determine the smoking trends of the young people affect which factors and how by considering the core issues, therefore, is of a great importance and priority due to providing actual information to policy makers and decision makers.
In order to reach to all the aims, the present study were planned to determine the factors impacting on smoking of the university students. The results of the study highlighted that the students increased the smoking trends and cigarette smoking amounts when gotten closer to the graduation years (p<0.01). Actually, they believed that increasing smoking causes them to feel in their confidence under an expanding social environment, and help them to reduce the stresses resulting from the density course pressures, and much lower WGPA score levels (p<0.01) and the professional anxieties in the future (Table 6). These results were supported by the results of some previous studies related to the increasing smoking rates influenced directly by economic and social environments of the participants conducted by Erdal et al. (2015), Mansour et al. (2015), Mudhovozi and Nyanga (2015), GATS (2014), Marques and Ikediobi (2010). Eldalo et al. (2015), Kulsoom and Afsar (2015), Topcu and Uzundumlu (2012), reported, moreover, that lower GPA scores along with higher stress, anxiety and depression also increased smoking proportions of the respondents.
The result of the study also indicated that there was a linear relationship between cigarette smoking amount and tea as well as water consumption amounts to be the complementary products (p<0.10). Smoking and alcohol consumption addicting make necessary not only a social environment but also the complementary products such as tea and water. Tea and water consumption, therefore, along with increasing smoking rate also rose linearly. Reich et al. (2011) reported that tea, coffee and water were widely used as the additional drinking substances among alcoholics and cigarette addicts by being similar to the results of the present study. If smoking bans applied between 2008 and 2010 years in Turkey are implemented similarly and controlled effectively by the public authorizers indoors and at the public places on today, the smoking rates could be decreased considerably.
The empirical results stated that their total expenditures within disposable income of the students due to increasing smoking rates and their complementary products were of a rising proportion (p<0.01). The results of the study analyzing the relations between smoking and its expenditures managed by Kilic and Ozturk (2014) reported that the young people with higher financial power consumed more and quality cigarette than the others.
As considered residence places impacting on going up smoking ration of the students, it was analyzed there was a positive correlation between staying at the rental apartments and smoking frequencies and amounts (p<0.01). This accommodation type is to allow the students to move more freely, and thus they could always smoke increasingly. In fact, the parameter had the biggest marginal impact on increasing smoking rate than the others. Fortified these findings, El Ensari et al. (2012) found that the students reduced gradually the concerns and tendencies to the accommodations applied the legal procedures preventing smoking.
The results of the study also showed that there were the linear relationships between internet using (p<0.01), exercising regularly (p<0.01), and having breakfast regularly (p<0.10) along with increasing smoking ration. Especially, young people have spent on the internet and with their mobile phone in recent years, and thus they have smoked consciously or unconsciously more than the other times. On the other hand, exercising and having breakfast regularly of the respondents increased smoking rates. When they always exercised regularly, they needed to have breakfast more than other students, and then to smoke increasingly by peaking up their physiological needs. These results were comply with the results of the previous studies organized by Audrain-McGovern et al. (2013) with regard to exercising regularly, Kim et al. (2010) about internet using, Keski-Rahkonen et al. (2003) related to having breakfast impacting on increasing smoking proportions of young people.
The empirical results of the study also exposed that there was an inverse correlation between the packed cigarette prices and smoking (p<0.01) due to demand theory. The students smoked cigarette more when its price reduced slightly (Table 6). The theoretical result was strengthened by Gil-Lacruz et al (2015) declaring to be affected negatively the smoking rates by means of higher prices and cautionary pictures on its package labels.
On the other hand, the results of the study identified that the mature women (p<0.01) with lower BMI (p<0.01) sleeping less (p<0.01) by educating at the engineering faculty (p<0.01) smoked noticeably less than the others. The results of the present study were affirmed by the results of the studies carried out by Campaña et al. (2015) reporting to be used less alcohol and cigarette at the engineering faculties rather than the economics and business ones, Gil-Lacruz et al. (2015) explaining to be smoked women much less rather than men in many developing countries, however, to be accepted as potential buyers of young people and women for the cigarettes selling by the tobacco companies. Additionally, Mansour et al. (2015) and Erdal et al. (2015) stated that the students ranging 18 and 25 years smoked fairly more than the other age groups. On the other hand, Baum (2009) and Undernet et al. (2006) also highlighted that there was a negative relation between not only BMI and smoking rate, but also less sleeping and that, respectively.
CONCLUSION
In recent years, smoking rates of young people and women in the developing countries have increased dramatically. Various legal arrangements on smoking prohibit indoors and at the public places were made by the government until 2008 years, and smoking rates reduced considerably from 2008 to 2010 years. These rates have, however, started to increase again nowadays due to the lacks of implementation and control with regard to legal arrangements preventing smoking. Therefore, in order to determine the attributes impacting on increasing smoking trends of the university students were designed for this study. The results of the study depicted that 23.0 percent of the students with 23.1 years smoked, and their cigarette material expenditures consisted of 25.0 percent of their total expenditures. In addition, it was stated that smoking students appreciated the biggest important to the cigarette brands with lower prices, stress reduction belief, and their friend environments.
The results of the study also highlighted that increasing smoking frequencies of the students were associated with approach to the graduate years, the consumption of the complementary goods, disposable income increase, and accommodation at the rental apartments, exercising and having breakfast regularly by using internet. On the other hand, the mature male with lower BMI educating at the engineering faculties under high WGPA scores smoked less than the other students at the other faculties by taking into consideration higher cigarette prices.
RECOMMENDATIONS
Firstly, the legal arrangements preventing smoking indoors and at the public places should be redesigned to respond to todayâs needs for young people, and then they should be implemented widely, and should be often controlled by public and local authorities. Individuals and the business owners/mangers infringing the smoking prohibits must be always punished rigorously. In addition, the governments should make the addiction substances control whether or not be normal levels, and the tobacco companies must apply a tolerance limit according to WHO criteria under government controls by considering the legal disclaimers by means of the visual instruction and superscriptions impacting negatively human healthy on the cigarette packages. In order to add these preventers; the governments must conduct effectively anti-smoking campaigns on real and social media, and it should be prevented the young people to reach to the cigarette bulks by being sold from higher prices under high taxes at a few selling points for mature people.
Secondly, the families should often control the relationships or links with the reference groups and social environments stimulating their young individuals by following whether or not smoke; and they should provide them to motive toward non-smoking groups. Their families should provide the students to accommodate, therefore, at the public or private dormitories rather than the rental apartments.
Finally, with the rearrangements for the syllabuses by being reduced the theoretical courses in favor of the applied courses at the social and health science faculties as at the engineering faculties, the students should be focused on scientific and computer laboratory studies, and thus the university administrators should provide them not only to have less free time but also the facilities such as libraries, lesson and rest halls, gyms at each faculty so as to do the various activities preventing their smoking. On the other hand, they should also provide the non-smoking students to derive benefit from the attractive social possibilities or facilities (fitness-center, café, cinema, various student clubs etc.) with flexible time schedule.
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Foodnote:
1 TRY=$1.91 in 2013
1 TRY=$2.13 in 2014.
Table1. Some socioeconomic and demographic characteristics of the participants (N=260)
Participants Gender Age
(years) Expenditure
($/month) Smoking expenditure ($/month)
female male female male female male female male
Smoking 10 50 23.0 23.3 715.1 779.0 113.6 161.9
Non-smoking 134 66 21.8 22.6 537.9 562.2 – –
Total/Average 144 116 21.9 22.9 550.2 656.0 7.9 69.8
Table 2. Residence places of the participants (N=260)
Participants Residence places
Public dormitories Private dormitories Rental apartment Others
Smoking 9 14 37 0
Non-smoking 50 49 90 11
Total 59 63 127 11
Table 3. The attitudes related to the media usage of the participants (N=260)
Participants Attitudes
Watching TV
(h/day) Internet using
(h/day) Social media using (h/day) Sleep duration
(h/day)
Smoking 2.17 3.5 3.1 7.8
Non-smoking 2.13 3.8 3.6 7.8
Average 2.14 3.7 3.5 7.8
Table 4. Some health-related attitudes of the participants (N=260)
Participants Some health-related attitudes
Body mass index Chronic diseases Having breakfast regularly Exercising regularly
Smoking 23.5 1 34 35
Non-smoking 22.5 15 125 99
Total/Average 22.7 16 159 134
Table 5. Weighted grade point average (WGPA) of the participants (N=260)
Participants WGPA
< 2.00 2.00-2.49 2.50-2.99 3.00-3.49 ⥠3.50
Smoking 10 24 22 4 0
Non-smoking 20 75 66 36 3
Total 30 99 88 40 3
Table 6. The attitudes of smoking students towards smoking (N=60)
Attitudes Smoking sensitivity (average)
I give a great importance to cigarette brand 3.5
I smoke more when the prices fall 3.3
Environmental affect and friend environment 3.3
Smoking reduces stress 3.2
I donât want to smoke, but I am addicted to smoking 3.0
I avoid to smoke indoors 2.8
My family is of a great impact on my smoking 2.4
Smoking gives confidence to me 2.1
Table 7. The attitudes of non-smoking students towards non-smoking (N=200)
Attitudes Non-smoking sensitivity (average)
Smoking is harmful for health 4.7
I donât put up with the smell and smoke of smoking 4.4
Smoking make my teeth look yellow 3.3
Smoking cost is very high 3.3
If I smoke, my parents will react against to me 2.9
If I smoke, my friends will react against to me 2.5
Everyone must comply with smoking ban indoor. 2.2
I choose my friends who donât smoke 2.1
Table 8. Empirical results of Zero Altered Poisson Regression Model
Variables Regression model Marginal effects Mean
Coefficient S.D. Coefficient S.D.
Constant 4.970*** 0.270 19.346 1.079 -
Price -0.038*** 0.010 -0.149 0.050 6.800
Engineering faculty (the others=0) -0.202*** 0.040 -0.788 0.162 0.392
Fourth graders 0.168*** 0.049 0.655 0.199 0.438
Gender (female=1) -0.184*** 0.059 -0.717 0.244 0.554
Age -0.050*** 0.008 -0.194 0.049 22.346
Education 0.006 0.008 0.024 0.052 14.777
Tea consumption 0.005* 0.003 0.019 0.041 5.258
Water consumption 0.012* 0.007 0.046 0.046 11.712
Expenditure 0.001*** 0.001 0.001 0.039 589.923
BMI (Body Mass Ind.) -0.025*** 0.005 -0.097 0.045 22.728
Rental apartments 0.207*** 0.055 0.804 0.227 0.488
Watching TV -0.002 0.011 -0.009 0.059 2.142
Internet using 0.030*** 0.009 0.117 0.055 3.695
Exercising regularly 0.198*** 0.043 0.769 0.177 0.515
Having breakfast regularly 0.068* 0.036 0.264 0.151 0.612
Awake up early -0.029 0.053 -0.111 0.212 0.492
Less sleeping -0.156*** 0.051 -0.609 0.208 0.169
Grade point average (WGPA) -0.144*** 0.053 -0.562 0.214 2.441
Chronic diseases 0.737 0.948 2.867 3.798 0.062
Tau statistics 0.393*** 0.049
Poisson log-likelihood -698.747
Z.I. Poisson log-likelihood -455.050
***p<0.01 **p<0.05 *p<0.10
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